Nicolai Chiropractic Center, P.C. offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! Choose the form appropriate to your age.
Please also select the Patient Health Questionnaire and the Electronic Health Records Intake Form.
New Patient Intake Form (Birth-6 years) - Download & Print
New Patient Intake Form (7-15 years) - Download & Print
New Patient Intake Form (16+ years) - Download & Print
Patient Health Questionnaire - Download & Print
Electronic Health Records Intake Form - Download & Print
Refresher Form (3 years + from last visit)- Download & Print
Financial, Informed Consent, and Privacy Information - Required
Financial Policy - Download & Print
Informed Consent - Download & Print
Consent for Use or Disclosure of Health Information - Download & Print
No Show Policy - Download & Print